Does Medicaid secondary cover copays from primary insurance?

Medicaid is the largest source of health coverage, covering more than 72 million Americans, and the Children Health Insurance Program (CHIP) is the second-largest health insurance for low-income Americans. Medicaid as a secondary cover can significantly reduce the bill. What that means is where your employer insurance or private insurance leaves, Medicaid will pick up and cover what the other insurance does not cover.  

Medicaid is a government-funded program that helps cover insurance premiums, copays, and deductibles for qualified low-income individuals and families. The eligibility criteria vary depending upon the individual’s state payment for that service. 

Medicaid as a Secondary Insurance 

Medicaid as secondary insurance depends upon the state’s guidelines. However, it comes with benefits like low copays, dental coverage, vision, and medical. For Marketplace plans, Medicaid cannot be secondary insurance, and therefore, you are not eligible for subsidized Marketplace coverage. 

To further elaborate on Medicaid as your secondary insurance, say your hospital bill is $4000, the deductible is $3000, and your insurance pays $1000 for the rendered service. Medicaid as your secondary insurance covers $2950 with a copay of $50. That means you only have to pay $50 that is the remaining amount for this service. Without secondary insurance, you have to pay $3000 for the service. 

It is convenient for scenarios where you have good medical coverage but no dental or vision coverage. Here the Medicaid will pay for dental and vision benefits with no out-of-pocket charges. 

Medicaid and other healthcare coverage

For Medicare recipients, Medicaid can be secondary insurance. Individuals with disabilities or seniors eligible for Medicaid receive help with their copays and deductibles from Medicaid. SSI (Supplemental Security Insurance) beneficiaries are entitled to Medicaid coverage.

In addition to interacting with other payers like Medicare, it gives extra help with medical costs and maximizes benefits. In case you decline Medicare Part D, contact your respective Medicaid office for maximum coverage. Medicaid is always the payer of last resort and ensures proper reimbursement rates provided to the beneficiaries with the full scope of coverage. 

This dual eligibility has a substantial impact on the healthcare continuum and thereby follows the COB rules for the payment between Medicare & Medicaid. Also, for coordinating Medicaid with the commercial policy, Medicaid is always the secondary payer so that the commercial policy covers the higher payment rate and avoids rebilling & scheduling delays. 

Medicaid and MCOs (Managed Care Organizations) 

Here the payment is tied to value rather than volume with additional oversight by the state. MCOs get paid a fixed capitation fee to provide higher quality care through the most efficient means possible.

Medicaid COBRA 

COBRA (The Consolidated Omnibus Budget Reconciliation Act) coverage exists for people who lose their job and still want to remain under the employer’s health insurance plan. In that case, the former employee is responsible for paying all premiums. 

Streamlining the COB process improves the reimbursement rates by reducing the administrative burden contributing substantially to the healthcare system.